Galasso Linda, Esposto Giorgio, Mignini Irene, Ainora Maria Elena, Zocco Maria Assunta
Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy.
World J Gastroenterol. 2025 Apr 28;31(16):102778. doi: 10.3748/wjg.v31.i16.102778.
In this editorial, we comment on the article by Teerasarntipan published in a recent issue of the . Dengue infection is a major mosquito-borne disease with global significance. Dengue-induced severe hepatitis (DISH) is a rare complication though severe, as it can lead to acute liver failure (ALF) with an incidence rate between 0.7% and 2.0% and mortality rates from 47.0% to 58.8%. In this context, the identification of patients at risk of ALF could improve prognosis in DISH patients. Teerasarntipan retrospectively enrolled 2532 dengue patients, counting 193 DISH and 20 ALF. The authors explored the prognostic role of liver-specific scores, as the model for end-stage liver disease (MELD) score, albumin-bilirubin (ALBI) score, easy (EZ)-ALBI score, and platelet-ALBI (PALBI) score. Univariate analysis identified international normalized ratio (INR), total bilirubin, albumin, and creatinine as independent laboratory factors associated with ALF, while age, gender, and liver comorbidities were not linked to in-hospital mortality. The presence of dengue shock syndrome significantly increased mortality, with an odds ratio (OR) of 28.05 (95%CI: 7.21-109.18, < 0.001). High INR and low albumin were laboratory markers associated with death from DISH, with ORs of 5.83 (95%CI: 2.59-13.12, < 0.001) and 0.15 (95%CI: 0.05-0.44, < 0.001), respectively. Multivariate analysis confirmed that INR remained the only significant predictor of both ALF and death, with adjusted ORs of 19.54 (95%CI: 3.37-113.38, < 0.001) and 3.86 (95%CI: 1.13-13.18, = 0.031), respectively. Among prognostic models, the MELD score performed best in predicting ALF, with a very high accuracy [area under the receiver operating characteristic curve (AUROC) of 0.929, 87.5% sensitivity, 89.3% specificity at a cutoff of 16], followed by the EZ-ALBI, ALBI, and PALBI scores, with AUROCs of 0.865, 0.832, and 0.797, respectively. As MELD remains the best scoring system for predicting poor outcomes in DISH-related ALF, EZ-ALBI is a valid adjunct tool that could improve medical care in these patients.
在这篇社论中，我们对Teerasarntipan发表在最近一期《 》上的文章进行评论。登革热感染是一种具有全球意义的主要蚊媒疾病。登革热诱发的严重肝炎（DISH）是一种罕见但严重的并发症，因为它可导致急性肝衰竭（ALF），发病率在0.7%至2.0%之间，死亡率在47.0%至58.8%之间。在此背景下，识别有ALF风险的患者可改善DISH患者的预后。Teerasarntipan回顾性纳入了2532例登革热患者，其中193例为DISH患者，20例为ALF患者。作者探讨了肝脏特异性评分的预后作用，如终末期肝病模型（MELD）评分、白蛋白-胆红素（ALBI）评分、简易（EZ）-ALBI评分和血小板-ALBI（PALBI）评分。单因素分析确定国际标准化比值（INR）、总胆红素、白蛋白和肌酐为与ALF相关的独立实验室因素，而年龄、性别和肝脏合并症与住院死亡率无关。登革热休克综合征的存在显著增加了死亡率，优势比（OR）为28.05（95%CI：7.21-109.18，P<0.001）。高INR和低白蛋白是与DISH死亡相关的实验室指标，OR分别为5.83（95%CI：2.59-13.12，P<0.001）和0.15（95%CI：0.05-0.44，P<0.001）。多因素分析证实，INR仍然是ALF和死亡的唯一显著预测因素，调整后的OR分别为19.54（95%CI：3.37-113.38，P<0.001）和3.86（95%CI：1.13-13.18，P = 0.031）。在预后模型中，MELD评分在预测ALF方面表现最佳，准确性非常高[受试者工作特征曲线下面积（AUROC）为0.929，截断值为16时敏感性为87.5%，特异性为89.3%]，其次是EZ-ALBI、ALBI和PALBI评分，AUROC分别为0.865、0.832和0.797。由于MELD仍然是预测DISH相关ALF不良结局的最佳评分系统，EZ-ALBI是一种有效的辅助工具，可改善这些患者的医疗护理。
